Comorbidity clusters in patients with moderate-to-severe OSA

Purpose Obstructive sleep apnea (OSA) is a prevalent and multifaceted disease. To date, the presence and severity of objectively identified comorbidities and their association with specific OSA phenotypes, CPAP adherence, and survival remain to be elucidated. The aim of this study is to cluster pati...

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Bibliographic Details
Published in:Sleep & breathing 2022-03, Vol.26 (1), p.195-204
Main Authors: Testelmans, Dries, Spruit, M. A., Vrijsen, B., Sastry, M., Belge, C., Kalkanis, A., Gaffron, S., Wouters, E. F. M., Buyse, B.
Format: Article
Language:English
Subjects:
Apnea
Cardiovascular diseases
Comorbidity
Continuous Positive Airway Pressure
Dentistry
Dyslipidemia
Female
Humans
Internal Medicine
Male
Medicine
Medicine & Public Health
Middle Aged
Neurology
Obesity
Otorhinolaryngology
Patients
Pediatrics
Phenotypes
Pneumology/Respiratory System
Retrospective Studies
Severity of Illness Index
Sleep
Sleep apnea
Sleep Apnea, Obstructive - complications
Sleep Apnea, Obstructive - mortality
Sleep Apnea, Obstructive - therapy
Sleep Breathing Physiology and Disorders • Original Article
Sleep disorders
Survival
Survival Rate
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Summary:Purpose Obstructive sleep apnea (OSA) is a prevalent and multifaceted disease. To date, the presence and severity of objectively identified comorbidities and their association with specific OSA phenotypes, CPAP adherence, and survival remain to be elucidated. The aim of this study is to cluster patients with OSA based on 10 clinically important objectively identified comorbidities, and to characterize the comorbidity clusters in terms of clinical and polysomnographic characteristics, CPAP adherence, and survival. Study design and methods Seven hundred ten consecutive patients starting CPAP for moderate-to-severe OSA were included. Comorbidities were based on generally accepted cutoffs identified in the peer-reviewed literature. Self-organizing maps were used to order patients based on presence and severity of their comorbidities and to generate clusters. Results The majority of patients were men (80%). They were generally middle-aged (52 years) and obese (BMI: 31.5 kg/m 2 ). Mean apnea-hypopnea index (AHI) was 41 ± 20 per h of sleep. More than 94% of the patients had one or more comorbidities with arterial hypertension, dyslipidemia, and obesity being the most prevalent. Nine comorbidity clusters were identified. The clinical relevance of these comorbidity clusters was highlighted by the difference in symptoms, PSG parameters, and cardiovascular risk. Also, differences in CPAP adherence, improvements in ESS, and long-term survival were present between the clusters. Conclusion Comorbidity prevalence in patients with OSA is high, and different comorbidity clusters, demonstrating differences in cardiovascular risk, CPAP adherence, and survival, can be identified. These results further substantiate the need for a comprehensive assessment of patients with OSA beyond the AHI.
ISSN:1520-9512
1522-1709
DOI:10.1007/s11325-021-02390-4